Jeanine's next step

After Jeanine came home from the hospital, we went back to see her Oncologist. He inferred that there was one last thing that could be done to unblock her biliary tubes. He told her she needed to go to a Radiation Oncologist. While Jeanine was otherwise busy, I talked to the oncologist myself and told him that Jeanine was living by herself at home. He suggested strongly that she is in a very precarious situation until she can get the biliary tubes unblocked. He said that someone needed to be with her most of the time.

This was my cue to move in with her. I did so on Wednesday. This cannot be a long term solution, but until we find out how her radiation is working, I will be with her at her home. I am not there 24/7 but pretty close to it.

The radiation oncologist met with Jeanine on Wednesday and told her that he can do pinpoint radiation on the specific tumor blocking her tubes (or are they ducts?). He also told her that there is a "fair chance" that it will work. You see, renal cell carcinoma is resistant to chemotherapy and radiation even if it is in the liver. He estimated that the chances were 50/50. That has made for a very nervous woman.

Jeanine is still a very vibrant yellow and the whites of her eyes are a nice yellow also. She gets very tired, manages to not throw up if she takes her anti-nausea medicine, has a lot of pain, and eats like a bird, but at least she is eating, she didn't in the hospital.

Jeanine's radiation begins Tuesday and she will do 5 weekdays of high-dose radiation. The doctor expects few side effects. The ones he mentioned were extreme tiredness and nausea. They said that it won't burn her skin or anything else but the tumor. The procedure that they are doing with her was developed for brain tumors and is very precise. She would welcome your prayers.

Jeanine comes home

Thursday Jeanine came home from the hospital after a roller coaster day. For the first time during her stay, her oncologist came in to see her. We know that he had been in communication with the other doctors because they had mentioned it and yet, Jeanine took great comfort when he came in. He is extremely intelligent and wants to try everything he can to help her. We are told that he remembers each patient and their treatment history. He also remembers the various treatments that are available without needing to look them up.

He gave her some options. First he told her that they might be able to implant radiation pellets in the liver that would deliver a powerful punch to the cancer, they could use radiation to decrease the tumor in the liver, they could go ahead and do the drains, then deliver targeted therapy to the liver. The decision was made and Jeanine was sent to the intervention radiologist to have a drain installed. It was a horrible experience for her. He could not get the drains to go in. According to the radiologist and his assistant, he tried it from many angles and pushed and shoved. When I imagine it, I imagine her insides looking like swiss cheese when he was done (though with much smaller holes.) They said she would be very, very sore and she definitely is.

After she recouped somewhat from the procedure, she was allowed to return home. She was so, so grateful to get back to familiar surroundings and to the relative quiet of home so she could get some rest.

Now the interesting part, there is no doubt that she is very, very sore in her abdominal area because of the fruitless procedure she went through yesterday. Yet, she has not thrown up once since she returned home. She is eating more, though still not much. She is more alert. She even thinks she might be a little less yellow. I am not sure that is true, but I do know that she is not acting as sick as she was. During the entire time she was at the hospital, the only things done that were different than what she does at home are..

1. They gave her some saline intravenously.
2. They did an unsuccessful procedure on her liver.

Whatever the reason, we are glad for the respite.

She has an appointment with her oncologist on Monday to find out the best course of action to follow at this point.

Jeanine and jaundice

Those of you who are in Jeanine's ward may have noticed that Jeanine looked pretty bad on Sunday. It won't come as a surprise to you that she not only looked bad but felt bad too. She noticed that she had a yellow tinge to her skin besides not feeling well. She decided to pick Monday for her monthly blood test. Tuesday, she got a call from her doctor's staff telling her to go to the ER immediately. She was at work and after a very shortened scheduled meeting headed to the ER. She had been told that her Bilirubin levels were too high.

When Jeanine and I arrived at the ER, she was shown back to her room quickly, but spent hours waiting for anything to happen. All they seemed to do was to ask the same questions over and over, but every once in a while a new one would creep in. Things like what color is your urine and when did it change, what color are your bowel movements and when did they change, are you eating, do you have nausea, do you vomit, do you itch? By this point, anyone looking at her knew that she was jaundiced. She had a lovely undertone of yellow and the whites of her eyes were yellow. It was official, she was jaundiced. They eventually got a room for her in the main hospital and ordered a CT scan. The results... her jaundice is caused by a blockage in the liver caused by her cancer. There is nothing they can do for the jaundice.

When she saw the gastroenterologist, he said that to make absolutely sure that there was no other mitigating factor, she needed to have a MRCP which would definitively show if there was an obstruction outside of the liver. There was not. After this test, though, he told her that there might be a reason to have a very good interventional radiologist insert drains into the something right at somewhere in the liver. Can you tell I am very unclear on what he told her? Basically the only reason that he would suggest it is so that she could continue with her chemotherapy. The jaundice (or blockage) makes it impossible to use some chemo treatments on her. It would not lengthen her life or improve her life in any other way. She told him that she needed to know what the oncologist thought and what the oncologist who is at the UCLA clinic thought about it. Since the MRCP, this morning she has been sitting at the hospital bored to death and very uncomfortable. She is still there presumably waiting for the doctors to decide what the best option is.

Now a little about Jeanine's condition, she is nauseous and vomits several times a day. This is caused by the jaundice. She is not interested in eating. She spent the entire morning eating 70 calories worth of rice chex and 1/2 of a small carton of milk. Protein is not easily digestible. She has lost approximately 5 lb. in the past week. When I left her at lunch time, she had eaten a banana and a couple of spoonfuls of egg salad. She is very tired. These are all side effects of jaundice. These symptoms have only occurred in the past month. Some were more recent than that. It seems to me that the cancer might be speeding up and causing more and more issues faster and faster. The doctors have not told us this, it is my impression. She doesn't always feel bad, we have played cards, read, talked and enjoyed each others company the last couple of days too. She says that she loves distractions. It makes her think less about what is happening to her and she feels somewhat better.

This is all the news I have to report at this point.

Another update on Jeanine

Every three or four months, Jeanine goes and has a PET scan which shows what is happening with her kidney cancer. It is a much dreaded occasion because of the bad news it can bring. She did that this week and today we went to the oncologist to hear the results. They were not good this time. She was told that the cancer is now invading the left lobe of her liver. Up to this point, it has managed to stay in the right lobe. She was also told that the cancer is actively growing in many of the lymph nodes where it had been previously spotted. I saw one result that said that that particularly spot had doubled in size since June of last year. She also has new lymph nodes that have cancer in them now. These include lymph nodes in her shoulder and in the pelvis area. I'd like to say that this was a surprise to me, but it was not. She has started having a big problem with nausea in the last several weeks, she has been much more tired and she has had a lot of pain in her lower back and other areas. She also has lost a lot of weight and has little appetite. We hoped that these might be issues with the side effects of the medicine, but the doctor said that specifically the nausea and pain in her lower back were most likely caused by the cancer itself. Since she is now using an anti-nausea medicine, her nausea and her appetite is much better. Surprisingly, she has found that the medicine has also helped the pain in her pelvis. The oncologist has taken Jeanine off the Avastin she has been on and has suggested that she go see a doctor at UCLA who is in the midst of a clinical trial on a new drug for Renal Cell Carcinoma. She has agreed to at least go there for a consultation. We'll see where it goes from there. The oncologist suggested that if she waited to try the new drug until after trying the treatments that he has to offer, the experimental drug most likely would not work. This is the time to try it. There was some good news in the PET scan. There seems to be no cancer in her bones. There are spots in the lungs, but they are not growing nor do they react to the dye injected when she is having the test suggesting they are caused by some other issue, such as scarring(?). These are normally likely candidates for Renal Cell Carcinoma, but there is no cancer apparent now. Jeanine continues to work and do her callings in Church. She comes to Sunday dinner at my home. We will see what will happen from here. Prayers and calls are appreciated.